Financial Incentives for Organ Donation

The National Kidney Foundation opposes all efforts to legalize payments for human organs for use in transplantation and urges the federal government to retain the prohibition against the purchase of organs that is codified in Title III of the National Organ Transplant Act of 1984.

Offering direct or indirect economic benefits in exchange for organ donation is inconsistent with our values as a society. Any attempt to assign a monetary value to the human body, or body parts, either arbitrarily, or through market forces, diminishes human dignity. By treating the body as property, in the hope of increasing organ supply, we risk devaluating the very human life we seek to save. Providing any form of compensation for organs may be an affront to the thousands of donor families and living donors who have already made an altruistic gift of life and it could alienate Americans who are prepared to donate life-saving organs out of humanitarian concern. In addition, it disregards families who are unable to donate organs but do consent to tissue donation.

Offering money for organs can be viewed as an attempt to coerce economically disadvantaged Americans to participate in organ donation. Furthermore, since the economically disadvantaged have been shown to be less likely to be organ transplant candidates, financial incentives for organ donation could be characterized as exploitation.

While payment for organs has real potential to undermine the transplant system in this country, its ability to increase the supply or organs for transplantation is questionable. In a recent survey of families who refused to donate organs of their loved ones who have died, 92% said that payment would not have persuaded them to donate. Public opinion polls and focus groups have disclosed that many Americans are not inclined to be organ donors because they distrust the U. S. health care system, in general, and, in particular, because they are concerned that the health care of potential organ donors might be compromised if their donor status were known. A program of financial incentives for organ donation is not likely to change these perceptions and, indeed, may aggravate mistrust. This is true even with the suggested subterfuge of paying the money to funeral homes. That strategy would most likely simply raise the price of a funeral without benefiting the family at all. Making financial incentives available at the time of death opens the possibility of creating new sources of tension and dissension between family members who are faced with the option of organ donation. Finally, a program of financial incentives for organ donation could expose transplant recipients to unnecessary risks because living donors and donor families would have an incentive to withhold information concerning the donor's health status so that they can be assured a financial benefit.

Proponents of financial incentives for organ donation assert that a demonstration project is necessary to confirm or refute the types of concerns mentioned above. The American Medical Association, the United Network for Organ Sharing and the Ethics Committee of the American Society of Transplant Surgeons have called for pilot studies of financial incentives. Conversely, the National Kidney Foundation maintains that it would not be feasible to design a pilot project that would definitively demonstrate the efficacy of financial incentives for organ donation. Moreover, the implementation of a pilot project would have the same corrosive effect on the ethical, moral and social fabric of this country that a formal change in policy would have. Finally, a demonstration project is objectionable because it will be difficult to revert to an altruistic system once payment is initiated, even if it becomes evident that financial incentives don't have a positive impact on organ donation.

The National Kidney Foundation believes that payment for organs is wrong. Such a practice should not be started or tested since its negative message could not be undone if, as research indicates, it will not work. The headline "Local Family Offered Money for Loved One's Organs" should never appear.

The National Kidney Foundation remains committed to doing everything that can rightly be done to alleviate the critical organ shortage. However, better understanding by the public, better practices from medical and procurement professionals, better organ preserving-care for post-transplant patients and increased living donation will help, not money. Any attempt to pay families to say yes is wrong.

Adopted: February 1, 2003

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